Healthcare Provider Details

I. General information

NPI: 1295722007
Provider Name (Legal Business Name): JP PHOTO AND BEAUTY SUPPLIES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 E 167TH ST
BRONX NY
10452-8203
US

IV. Provider business mailing address

72 E 167TH ST
BRONX NY
10452-8203
US

V. Phone/Fax

Practice location:
  • Phone: 718-538-8100
  • Fax: 718-538-8118
Mailing address:
  • Phone: 718-538-8100
  • Fax: 718-538-8118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number027314
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number027314
License Number StateNY

VIII. Authorized Official

Name: MR. ROBERT LEE
Title or Position: PRESIDENT
Credential:
Phone: 718-538-8100